Learning To Climb Mountains In Telluride

Bear Creek Trail is a trail that gets people thinking. In addition, it allowed me to truly appreciate the beauty of Telluride. We were surrounded by countless trees, mountains, and best of all a group of individuals dedicated to changing the culture of medicine.  2.33 miles hiked plus 2400 ft climbed, and now we were nearly 11,000 ft above sea level. The farther we climbed, the more beauty we could see. “Beautiful” does not even come close to how amazing the view was.

The same thing can be applied to healthcare in regards to patient safety and quality. In a hospital, we also have several mountains to climb. For example, we have to recognize that patients are not the only people who need medical care. 10% of physicians will have a problem with drug abuse during their career. A large chunk will struggle with an addiction to alcohol, but it can also include opioids or other drugs. Furthermore, over 400 physicians are lost to suicide every year. About .11 nurses out of every 1000 will commit suicide. That does not seem like a high number, but compared to a national rate of .07 out of every 1000, it is significant.  Thus it is quite clear that medical professionals are affected in a negative way by the work that they do in the hospital. The medical teams have to be prepared for everything. They have to witness horrific events such as a young child dying of a rare disease or a patient coming in with significant trauma. They may have to give their patient news of cancer, HIV transmission, death, etc.

Regardless, it is clear that the medical team has a lot to handle. Unfortunately, they are taught to act as emotionless as possible. It is generally frowned upon to show emotion to a patient. Crying is simply not tolerated by many medical professionals. Physicians are often afraid that by showing remorse they are admitting some sort of guilt. This is not true. We as physicians are human beings. We have emotions and there is no way that it is possible to turn them off in the hospital and turn them back on when we leave each day.

The events that occur in the hospital will be carried with us for the rest of our career. They will enter our daily lives no matter how much we try to block them out. Thus it is important to address them head on and get help if we really do need it. We,as a medical team, have a multitude of resources available to us and we know exactly where these resources are located. The one thing we have to learn though is that there is no way to eliminate these completely. Healthcare as a profession needs to do a better job at helping these people before they continue to suffer/commit suicide.

Another mountain that we must climb as a medical team is making the shared decision-making easier for our patients. Essentially, there needs to be more collaboration between medical teams and their patients when medical decisions are being made. Doctors need to propose all of the options that are available to their patient and find the best option that meets all of a patient’s needs/wants. While this sounds easy, in practice it becomes difficult. There may be a procedure that a patient wants that a doctor does not have the proper experience for and as a result the doctor may have to refer the patient to another doctor/hospital. Again, that sounds like an easy thing to do, but we as a medical profession do not like to disclose things. We do not like to be transparent about a  “lack of experience” and as a result may not even mention this procedure as an option to a patient. For instance, we do not make it a point to tell our patients that new interns come into the hospital July 1st every year.

Informed consent is another huge mountain that we must climb as a medical profession. An informed consent is a paper that describes the inherent risks and benefits associated with a procedure/test. The main problem is that this paper is written in a language understood by medical professionals, but not by our patients. How can we possibly expect a patient who has a reading level of a 5th grader to understand and adequately consent to a procedure? What about a patient who is sedated?

Moreover, the responsibility of getting an informed consent form signed may be left to a medical student or an intern. While this may sound harmless, there’s an innate pressure on the student or the intern to return to the attending with those forms signed. Thus there is coercion and motive for the student and intern to do almost anything in order to get those forms signed. Even if its the surgeon who is getting the form signed, he has an financial incentive to convince the patient that the procedure is the right thing to do. Thus I ask, should we have a third-party informed consent team? They could spend the needed time to consent patients and give them all the options. While it would be costly, they could advocate for the patient and help the patient make some of their medical decisions instead of leaving it up to the medical team.

To conclude, there are still several mountains to climb in healthcare. We are making progress and the farther we go up these mountains, the more beauty that we will be able to see. There will be falls along the way, but we have to keep pushing if we ever want to get to the top.